[英文学习和病例讨论]激烈头痛引起心跳骤停（尸解报告已经公布）
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There has an alert and oriented to 40-year-old male, complaining of a terrible headache. He tells that it's the worst headache ever and is mostly in the back of the head. He has also been dizzy, has vomited and has a stiff neck. He denies any recreational drug use. His history is:
The patient denies any heart or lung problems. He also states that he has no history of high blood pressure, diabetes or seizures. His only history is of migraine headaches. He doesn't have a fever. The pain is in the back of his head. Vital signs: BP 140/80; HR 100; RR 18; CR 1 sec; and diaphoretic skin.
His only medication is the Imitrex that he takes for the migraines. While talking to the patient, you place him on high-flow oxygen. He tells that he's still very nauseated and feels like he's going to vomit again. He proceeds to do just that —wonderful, another vomiting, migraine-headache patient.
Then the patient looks really pale, and you begin to move him to the vehicle. Once inside, you repeat the vital signs. While you're doing this, your patient suffers a grand mal seizure and stops breathing. Your partner ventilates him with a bag-valve mask, and you take his pulse and realize that he's in cardiac arrest.
Compressions are started. As you head to the hospital, your partner gets the endotracheal (ET) tube in and you check the ECG. It shows asystole. You administer epinephrine via the ET tube without any change. You apply the transcutaneous pacemaker to the patient, but his heart fails to capture, leaving him in a flat-line rhythm.
On arrival at the hospital, nothing has changed. The emergency department physician terminates resuscitation efforts after 20 minutes, and bedside ultrasound confirms that there is no heart wall motion.
一个40岁的男性患者，因为激烈头痛要求出车急救。患者述说曾经有过严重的头痛病史，发作时主要以后脑部疼痛为主。也有过眩晕，呕吐和颈部僵硬感。否认有应用任何娱乐性的药物。
他的现病史如下：患者否认有心肺毛病。也无高血压病史，糖尿病病史和癫痫发作病史。唯一的就是有偏头痛病史。 无发热。本次的头痛也是在后脑部。生命体征：BP 140/80; HR 100; RR 18; CR 1 sec; 皮肤潮湿。
他唯一的用药史是应用琥珀酸舒马普曲坦注射剂以治疗偏头痛。在与患者交谈的过程中，让患者吸高流量的氧气。他仍然感觉恶心厉害，又想呕吐。不久就呕吐了。印象是一个，呕吐，偏头痛的患者。
患者脸色苍白，着手把患者搬上救护车。在救护车内再次检查患者的生命体征。在检查的过程中，患者出现癫痫大发作，并且出现了呼吸停止，马上予以简易呼吸气囊人工呼吸，检查脉搏发现患者已经出现心跳停止。
马上予以胸外按压。在往医院的途中，予以患者气管插管和心电图检查。心电图证实心搏停止。 予以经皮胸外起搏，但是起搏无效，心电监护提示仍然为平坦的直线。
在到达医院以后，情况并没有好转，在急诊科继续心肺复苏２０分钟，床边超声检查证实没有心室壁的活动，最后宣告临床死亡。
========================================>
该病例有什么特点？有什么诊断的线索？
该患者应该如何鉴别诊断？
我们应该如何克服思维的定势？
按照思维习惯我们应该如何诊断？
大家有什么想法，如何深入的讨论这些问题，应该吸取什么教训？
The patient denies any heart or lung problems. He also states that he has no history of high blood pressure, diabetes or seizures. His only history is of migraine headaches. He doesn't have a fever. The pain is in the back of his head. Vital signs: BP 140/80; HR 100; RR 18; CR 1 sec; and diaphoretic skin.
His only medication is the Imitrex that he takes for the migraines. While talking to the patient, you place him on high-flow oxygen. He tells that he's still very nauseated and feels like he's going to vomit again. He proceeds to do just that —wonderful, another vomiting, migraine-headache patient.
Then the patient looks really pale, and you begin to move him to the vehicle. Once inside, you repeat the vital signs. While you're doing this, your patient suffers a grand mal seizure and stops breathing. Your partner ventilates him with a bag-valve mask, and you take his pulse and realize that he's in cardiac arrest.
Compressions are started. As you head to the hospital, your partner gets the endotracheal (ET) tube in and you check the ECG. It shows asystole. You administer epinephrine via the ET tube without any change. You apply the transcutaneous pacemaker to the patient, but his heart fails to capture, leaving him in a flat-line rhythm.
On arrival at the hospital, nothing has changed. The emergency department physician terminates resuscitation efforts after 20 minutes, and bedside ultrasound confirms that there is no heart wall motion.
一个40岁的男性患者，因为激烈头痛要求出车急救。患者述说曾经有过严重的头痛病史，发作时主要以后脑部疼痛为主。也有过眩晕，呕吐和颈部僵硬感。否认有应用任何娱乐性的药物。
他的现病史如下：患者否认有心肺毛病。也无高血压病史，糖尿病病史和癫痫发作病史。唯一的就是有偏头痛病史。 无发热。本次的头痛也是在后脑部。生命体征：BP 140/80; HR 100; RR 18; CR 1 sec; 皮肤潮湿。
他唯一的用药史是应用琥珀酸舒马普曲坦注射剂以治疗偏头痛。在与患者交谈的过程中，让患者吸高流量的氧气。他仍然感觉恶心厉害，又想呕吐。不久就呕吐了。印象是一个，呕吐，偏头痛的患者。
患者脸色苍白，着手把患者搬上救护车。在救护车内再次检查患者的生命体征。在检查的过程中，患者出现癫痫大发作，并且出现了呼吸停止，马上予以简易呼吸气囊人工呼吸，检查脉搏发现患者已经出现心跳停止。
马上予以胸外按压。在往医院的途中，予以患者气管插管和心电图检查。心电图证实心搏停止。 予以经皮胸外起搏，但是起搏无效，心电监护提示仍然为平坦的直线。
在到达医院以后，情况并没有好转，在急诊科继续心肺复苏２０分钟，床边超声检查证实没有心室壁的活动，最后宣告临床死亡。
========================================>
该病例有什么特点？有什么诊断的线索？
该患者应该如何鉴别诊断？
我们应该如何克服思维的定势？
按照思维习惯我们应该如何诊断？
大家有什么想法，如何深入的讨论这些问题，应该吸取什么教训？
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